Cervicitis

Definition/diagnostic criteria
Cervicitis is an inflammation of the cervix, often caused by infection but also potentially due to non-infectious causes such as chemical irritation or trauma. It can be acute or chronic. The condition is commonly linked to sexually transmitted infections (STIs), such as Chlamydia trachomatis or Neisseria gonorrhoeae. Non-infectious cervicitis may arise from irritants like contraceptives or from douches. Diagnosis is based on clinical findings, which include erythema, oedema, mucopurulent discharge, and friability of the cervical tissue upon examination.

Epidemiology
Cervicitis is a common presentation in sexually active women, particularly those aged under 25, as this group is more likely to be exposed to STIs. In the UK, Chlamydia trachomatis is the most frequently reported bacterial STI, with approximately 200,000 new diagnoses each year according to Public Health England. Neisseria gonorrhoeae is less prevalent but remains significant. Risk factors include multiple sexual partners, new sexual partners, inconsistent condom use, and a history of prior STIs.

Diagnosis

Clinical features
Many women with cervicitis are asymptomatic, but common symptoms, when present, include vaginal discharge (often purulent), post-coital bleeding, intermenstrual bleeding, and dyspareunia. Pelvic pain may also be reported, although this is more typical in cases of associated pelvic inflammatory disease (PID). On speculum examination, the cervix may appear erythematous, with mucopurulent endocervical discharge, and may bleed easily on contact (friability).

Investigations
Women presenting with cervicitis require a full STI screen. This includes testing for Chlamydia trachomatis and Neisseria gonorrhoeae using nucleic acid amplification tests (NAATs) from a cervical or vulvovaginal swab, or first-pass urine samples. These tests will usually be performed by specialist STI clinics.

Treatment
Empirical treatment may be appropriate for cervicitis if an STI is suspected while awaiting test results. The first-line treatment for cervicitis caused by Chlamydia trachomatis is doxycycline 100mg twice daily for 7 days. Alternatively, azithromycin 1g as a single dose is an option. If Neisseria gonorrhoeae is confirmed or suspected, dual therapy with ceftriaxone 1g intramuscularly plus azithromycin 1g orally is recommended due to concerns over antibiotic resistance.

Otherwise, treatment will be guided by the results of swab tests and arranged by the STI clinic.

Sexual partners should be notified, tested, and treated accordingly to prevent reinfection, and patients should be advised to abstain from sexual intercourse until treatment is completed and both partners are confirmed negative for STIs. Regular STI screening and the use of condoms should be encouraged as preventive measures.

Prognosis
With appropriate treatment, cervicitis has a good prognosis, with symptoms typically resolving within a week. However, untreated cervicitis, especially when caused by Chlamydia trachomatis or Neisseria gonorrhoeae, can lead to complications, including PID, infertility, and an increased risk of ectopic pregnancy. Recurrent or persistent cervicitis warrants further investigation, as this may indicate non-infectious causes, antibiotic resistance, or infection with less common pathogens. Routine follow-up may not be required unless symptoms persist or the patient has tested positive for gonorrhoea, in which case a test of cure should be performed.